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HX641 26480 

RC148.M72  Rabies  or  hydrophobi 


RECAP 


■X)HLEi\ 


RABIZ3  OR  HYDTOPHOBIA 


Rc/Vg> 


rAiJi 


College  of  ^ijpsiicians  anb  ^urgeong 
Hitjrarp 


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http://www.archive.org/details/rabiesorhydrophoOOmohl 


Icsaed  May  12,  1911- 


U.  S.  DEPARTMENT   OF   AGRICULTURE. 


FARMERS'    BULLETIN    449. 


lABIES  OR  HYDROPHOBIA, 


JOHN  R.  MOHLER,  V.  M.  D., 

Chief  of  the  Pathological  Division,  Bureau  of  Animal  Industry, 


WASHINGTON: 

GOVERNMENT   PRINTING   OFFICE. 

1911. 


LETTER  OF  TRANSMITTAL 


U.  S.  Department  of  Agriculture, 

Bureau  of  Animal  Industry, 

Washington^  D.  C.^  March  IJj,^  1911, 

Sir  :  I  have  the  honor  to  transmit  herewith,  and  to  recommend  for 
)ublication  as  a  Farmers'  Bulletin,  a  paper  on  "  Rabies,  or  Hydro- 
jhobia,"  by  Dr.  John  R.  Mohler,  chief  of  the  Pathological  Division 
)f  this  bureau.  This  paper  is  based  on  an  article  which  forms  a  part 
)f  the  Twenty-sixth  Annual  Report  of  this  bureau. 

The  disease  known  as  rabies  in  animals  and  hydrophobia  in  man 
s  one  of  the  most  terrible  maladies  known  to  medical  science. 
Uthough  some  skepticism  as  to  this  disease  persists  and  is  industri- 
)usly  fostered  by  the  publication  of  erroneous  views,  the  reality  and 
he  infectious  nature  of  the  malady  have  been  abundantly  established 
nd  confirmed  by  the  work  of  nmnerous  competent  scientific  investi- 
gators, and  there  is  no  more  reason  for  doubting  the  existence  of 
abies  than  for  questioning  the  actuality  of  other  specific  and  well- 
ecognized  contagious  diseases. 

Rabies  is  prevalent  among  dogs  in  various  parts  of  the  United 
States,  and  the  presence  of  infected  animals  is  a  constant  menace  to 
luman  life.  Under  this  condition  the  relative  infrequency  of  deaths 
mong  people  who  have  been  bitten  by  rabid  dogs  is  due  to  the  pro- 
ection  afforded  by  the  Pasteur  treatment.  Even  with  this  treatment, 
towever,  considerable  anxiety,  suffering,  hardship,  and  expense  are 
ntailed  upon  many  people;  and  it  must  also  be  remembered  that  for 

number  of  reasons,  not  the  least  of  which  are  the  inconvenience  and 
xpense  involved,  a  large  proportion  of  the  persons  and  practically 
11  the  animals  that  have  received  the  virus  through  bites  do  not 
ndergo  this  treatment. 

Theoretically,  rabies  is  one  of  the  most  easily  eradicated  of  conta- 
•ious  diseases,  but  practically  the  undertaking  is  beset  with  difficulties, 
ill  that  is  required  is  the  muzzling  of  all  dogs  for  a  sufficient  time, 
'his  has  been  amply  proved  by  the  experience  of  several  European 
auntries  where  the  disease  has  been  stamped  out  in  this  manner. 
>ut  the  carrying  out  of  such  a  measure  in  this  country  is  not  easy, 
iffective  action  can  not  be  taken  by  the  Federal  Government  alone ; 
]  is  necessary  to  have  the  cooperation  of  the  States  and  municipalities 
nd  of  the  people  at  large.  It  seems  desirable,  therefore,  that  the 
iformation  contained  in  the  accompanying  paper  be  given  the  widest 
ublicity. 

Respectfully,  A.  D.  Melvin,  Chief  of  Bureau. 

Hon.  James  Wilson, 

Secretary  of  Agriculture. 

I  449  3 


CONTENTS, 


Nature  and  characteristics  of  the  disease 

Cause  of  the  disease 

Symptoms 

Furious  rabies  in  the  dog 

Dumb  rabies  in  the  dog 

Rabies  in  cattle 

Rabies  in  cats 

Post-mortem  appearances 

Transmission  of  the  disease  by  milk  and  meat. 

Differential  diagnosis 

Distribution  and  prevalence 

In  the  United  States 

In  other  countries 

Prevention  and  eradication 

Dog  license 

Necessity  for  muzzling 

449 

4 


RABIES  OR  HYDROPHOBIA. 


NATURE  AND  CHARACTEEISTICS  OF  THE  DISEASE. 

Skepticism  with  reference  to  the  existence  and  prevalence  of  rabies 
n  animals,  or  hydrophobia  in  man,  strange  as  it  maj^  seem,  is  still 
mtertained  by  a  few  prominent  professional  men.  Their  contention 
shows  an  unwillingness  to  acce^Dt  the  work  of  rex^utable  investigators 
(vith  regard  to  this  particular  disease,  although  other  results  obtained 
:>y  the  same  investigators  upon  allied  subjects  are  accepted  and  advo- 
'ated.  There  is  no  greater  galaxy  of  names  associated  with  the  study 
)f  any  of  the  infectious  diseases  than  is  connected  with  the  experi- 
nental  investigation  of  rabies.  The  ablest  scientists  who  have 
idorned  the  medical  and  veterinary  professions,  and  to  whom  we 
)we  the  greatest  deference  for  having  advanced  our  knowledge  of 
,'ontagious  diseases,  have  repeatedly  shown  hj  their  experiments  that 
•abies  is  a  specific,  communicable  disease,  preeminently  affecting  the 
:anine  race,  although  all  warm-blooded  animals,  including  man,  are 
;uscej)tible  to  it. 

Many  years  of  patient  scientific  research  have  been  required  to  lead 

hese  investigators  to  a  clear  comprehension  of  the  nature  and  char- 

icteristics  of  this  disease.      It  was  known  and  described  several  cen- 

uries  prior  to  the  beginning  of  the  Christian  era,  and  from  the  dawn 

if  history  the  disease  has  been  feared  and  dreaded.     But  it  has  been 

►nly  in  comjoaratively  recent  j^ears  that  we  have  arrived  at  a  tolerably 

lear  understanding  of  the  facts  concerning  this  disease,  which  have 

jO  a  certain  degree  displaced  many  of  the  fallacies  and  superstitions 

hat  have  had  a  strong  hold  upon  the  public  mind  for  many  years. 

ndeed,  it  is  still  a  widel}^  prevalent  belief  that  if  persons  or  animals 

re  bitten  by  a  dog  they  are  liable  to  become  rabid  if  the  dog  should 

ontract  the  disease  at  any  future  time.     There  is  no  foundation  for 

his  impression,  and  it  would  be  a  great  comfort  to  many  people  who 

re  now  and  then  bitten  by  animals  if  the  fallacy  of  this  idea  Avere 

ppreciated.      All  experience,  both  scientific  and  practical,  goes  to 

how  that  rabies  is  transmitted  only  bv  animals  that  arc  actuallv  dis- 
1  .  .      .  ,  .     "       . 

ased  at  the  time  the  bite  is  inflicted.     Under  natural  conditions  this 

3  the  sole  method  by  which  the  disease  is  transmitted,  and  therefore 

449  .  5 


6  RABIES   OR   HYDROPHOBIA. 

the  old  idea  of  spontaneous  generation  of  the  malady  is  absolutely' 
fallacious.  Artificiall}',  it  may  be  readily  produced  by  inoculating 
susceptible  animals  with  an  emulsion  of  the  brain  or  spinal  cord  or 
with  the  saliva,  milk,  and  other  secretions  of  the  affected  animal. 
The  blood,  on  the  other  hand,  seems  to  be  free  from  the  infectious 
principle.  The  saliva  contains  the  virus  which  under  natural  con- 
ditions is  introduced  into  or  under  the  skin  on  the  tooth  of  the  rabid 
animal. 

Following  the  canine  race,  cattle  seem  to  be  the  most  frequently 
affected,  probably  because  rabid  dogs,  next  to  their  morbid  desire  to 
attack  members  of  their  own  race,  have  a  better  opportunity  to  bite 
grazing  cattle  than  any  other  species  of  animals.  The  relative  fre- 
quency of  rabies  in  these  two  species  of  animals  is  indicated  by  the 
carefully  compiled  statistics  of  the  German  Empire,  which  show  that 
560  dogs  and  78  cows  died  of  rabies  in  1901,  while  in  1902  there  were 
516  cases  in  dogs  and  77  in  cattle. 

Every  animal  or  jDerson  bitten  does  not  necessarily  develop  the 
disease  and  the  percentage  of  fatalities  has  been  variously  estimated. 
According  to  Hogyes  the  proportion  of  persons  who  contract  the 
disease  after  being  bitten  by  rabid  dogs  and  not  treated  is  conserva- 
tively estimated  at  15  per  cent.  The  percentage  is  considerably 
higher  in  man  following  bites  by  the  wolf.  From  35  to  45  per  cent 
of  the  dogs,  40  per  cent  of  the  horses,  36  per  cent  of  the  hogs,  and 
from  25  to  30  per  cent  of  the  cattle  bitten  by  rabid  animals  contract 
the  disease,  making  a  general  average  of  about  30  per  cent.  This, 
however,  depends  on  the  location  and  size  of  the  wound,  as  well  as 
the  amount  of  hemorrhage  produced,  and  various  other  conditions. 
In  general,  the  nearer  the  bite  is  located  to  the  central  nervous  system, 
and  the  deeper  the  wound  is  inflicted,  the  greater  is  the  danger  of  a 
fatal  result.  In  case^  where  the  hemorrhage  resulting  from  the  bite 
is  profuse,  there  is  a  possibility  that  the  virus  will  be  washed  out  of 
the  wound  and  thus  obviate  the  danger  of  subsequent  appearance  of 
the  disease. 

The  virus  after  being  deposited  in  the  wound  remains  latent  for 
an  extremely  variable  period  of  time,  which  also  depends  on  the  size 
and  depth  of  the  wound  as  well  as  its  location  and  the  amount  of 
virulent  saliva  introduced.  Experiments  have  proved  that  the  virus 
follows  the  course  of  the  nerves  to  the  spinal  cord  and  along  the  lattei'j 
to  the  brain  before  the  symptoms  appear.  Gerlach,  having  collected 
statistics  from  a  large  number  of  cases,  has  found  the  period  between 
the  bite  and  the  appearance  of  the  first  symptom  to  vary  from  14  to 
285  days.  The  great  majority  of  cases,  however,  contract  the  disease 
in  from  three  weeks  to  three  months  after  the  bite  has  been  inflicted.. 
It  has  been  clearly  demonstrated  by  the  experiments  of  Roux  and 

449 


BABIES    OR  HYDROPHOBIA.  7 

Nocard  that  the  bite  of  a  dog  is  infectious  at  least  three  days  before 
it  manifests  symptoms  of  rabies,  while  at  the  Athens  (Greece)  Pasteur 
Institute  infection  was  noted  in  the  saliva  eight  days  before  the  dog 
showed  signs  of  the  disease. 

CAUSE  OF  THE  DISEASE. 

Rabies  is  a  specific  infectious  disease  involving  the  nervous  system 
and  characterized  by  extreme  excitability  and  other  disorders,  prac- 
tically alwaj^s  terminating  in  death.  The  contagion  of  this  disease 
has  never  been  isolated,  but  the  fact  that  the  disease  is  caused  by  a 
specific  organism  principally  found  in  the  nervous  system  is  indis- 
putable. For  instance,  if  an  emulsion  of  the  brain  of  a  rabid  animal 
is  rapidly  filtered  through  a  fine  Pasteur-Chamberland  filter,  the 
filtrate  will  be  harmless.  On  the  other  hand,  if  a  similar  emulsion  is 
filtered  through  the  more  porous  Berkefeld  filter,  the  virus  will  be 
found  in  the  filtrate.  This  fact  indicates  that  the  infectious  principle 
is  not  in  solution,  but  is  an  organism  of  such  size  as  to  be  withheld 
from  the  filtrate  by  a  very  fine  filter.  Further  proof  of  the  organic 
nature  of  the  virus  is  furnished  by  the  fact  that  heating  at  50°  C.  for 
one  hour  will  render  the  vinilent  emulsion  inert,  while  similar  re- 
sults follow  its  exposure  to  light  for  14  hours,  to  the  usual  antiseptic 
solutions  for  a  short  period,  or  to  the  action  of  the  gastric  juice. 

This  contagion  can  be  propagated  only  in  the  body  of  an  animal, 
and  despite  numerous  attempts  to  cultivate  it  artificially  upon  various 
culture  media  only  negative  results  have  followed. 

There  is  no  doubt  that  between  rabies  and  other  well-known  in- 
fectious diseases  there  are  analogies  at  many  points,  the  most  striking 
being  the  protective  immunization  which  constitutes  the  great  work 
3f  Pasteur.  Moreover,  the  disease  is  transmitted  from  one  animal  to 
another  through  a  long  series,  which  indicates  the  presence  of  a  living 
organism  capable  of  multiplication,  rather  than  a  mere  toxin  which 
?vould  naturally  become  greatly  diluted  and  innocuous  by  passage 
through  such  a  series.  In  addition,  the  behavior  of  the  disease  makes 
as  certain  that  it  is  caused  by  a  specific  micro-organism  which,  after 
ntroduction  into  the  body,  undergoes  a  period  of  incubation,  during 
vvhich  it  multiplies  and  subsequently  produces  certain  definite  symp- 
;ons  and  lesions  which  terminate  in  death. 

Innumerable  attempts  have  been  made  to  discover  the  causative 
igent,  and  investigators  have  announced  the  finding  of  many  of  the 
ower  forms  of  animal  and  vegetable  life  as  the  pathogenic  factor, 
"^mong  the  recently  described  causes  certain  protozoan-like  bodies, 
found  in  1903  by  Negri  in  the  ganglionic  cells,  and  termed  Negri 
)odics,  are  of  a  very  suggestive  nature.  Negri  claims  that  these 
)odies  are  not  only  specific  for  rabies  but  that  they  are  protozoa  and 

449 


8  RABIES    OR   HYDROPHOBIA. 

the  cause  of  the  disease.  His  work  has  been  corroborated  by  investi- 
gators in  all  parts  of  the  scientific  %Yorld.  An  examination  of  the 
vitality  of  Negri  bodies  will  show  a  striking  resemblance  to  the 
vitality  of  an  emulsion  of  the  virulent  tissue.  Thus,  Xegri  bodies 
have  been  found  to  be  quite  resistant  to  external  agencies,  such  as 
putrefaction,  drying,  etc..  and  are  about  the  last  portion  of  the  nerve 
cell  to  survive  the  advance  of  decomposition.  Thej^  are  also  found  in 
over  96  per  cent  of  the  cases  of  rabies  examined,  but  have  not  been 
proved  to  exist  in  other  diseases. 

Valenti  states,  as  his  strongest  evidence  of  the  protozoan  nature  of 
the  bodies,  that  the  virus  of  rabies  is  neutralized  in  test  tubes  by 
quinin,  while  no  other  alkaloid  has  this  property.  As  a  result  of  the 
work  performed  in  the  Xew  York  Cit}^  board  of  health  laboratory'-, 
Park  claims  that  Negri  bodies  are  found  in  animals  before  the  begin- 
ning of  visible  symptoms,  and  evidence  is  given  that  they  may  be 
found  early  enough  to  acount  for  the  infectiousness  of  the  central 
nervous  system.  These  bodies  are  now  almost  universally  consiclered 
as  diagnostic  of  rabies,  and  in  the  pathological  laboratory  of  the 
Bureau  of  Animal  Industry  their  detection  in  the  nerve  cells  of  the 
brain  suffices  for  a  diagnosis  of  rabies  without  animal  inoculations. 
In  case  these  granular  bodies  are  not  found  in  a  suspected  animal,  the 
plexiform  ganglion  is  next  examined,  and  should  negative  results  still 
be  obtained  the  inoculation  of  rabbits  is  then  made  as  a  last  resort. 
It  is  indeed  rare  that  positive  results  are  obtained  from  the  latter 
method  after  the  first  two  methods  have  been  negative,  but  it  has 
occurred  occasionally  in  cases  where  the  animal  had  been  killed  in 
the  early  stages  of  the  disease. 

SYMPTOMS. 

The  symptoms  of  rabies  are  quite  characteristic,  and  may  be  di- 
vided into  two  types — (1)  the  furious,  violent,  or  irritable,  and  (2) 
the  dumb  or  parah'tic.  They  vary  somewhat  in  each  species,  but 
as  the  disease  in  the  dog  is  the  most  important,  it  will  receive 
principal  attention  at  this  time. 

FURIOUS   RABIES   IN   THE   DOG. 

Following  the  period  of  incubation  of  the  disease,  which  is  usually 
between  three  weeks  and  three  months,  there  is  first  noticed  in  the 
furious  form  of  rabies  a  marked  change  in  the  disposition  of  the 
animal,  which  should  at  once  arouse  suspicion.  An  affectionate  dog 
may  become  morose  and  depressed,  while  a  snapping,  treacherous 
animal  may  become  cowardly  or  affectionate.  This  is  known  as  the 
stage  of  development,  and  in  one  or  two  days  is  followed  by  an' 


RABIES    OE    HYDEOPHOBIA.  9 

irresistible  tehdency  to  roam.  If  prevented  the  dog  will  fight  or 
bite  at  the  restraint  or  at  anything  that  interferes  with  his  freedom. 
This  roving  may  occur  for  one  to  three  days,  during  which  he  travels 
aimlessly  in  a  nervous  and  irritable  condition.  His  instinctive 
methods  of  defense  are  nearly  alwa5^s  highly  developed  or  exag- 
gerated, but  he  seldom  willfully  attacks  persons  or  other  animals 
without  provocation.  When  he  returns,  if  not  destroyed  in  the 
meanwhile,  he  shows  from  his  exhausted,  dirty,  sheepish,  or  de- 
pressed appearance  evidences  of  wandering.  Having  returned  home, 
he  frequently  seeks  secluded  places  such  as  are  found  under  the 
jhouse  or  porch. 

During  this  period  of  roving  he  exhibits  a  disposition  to  eat  or 
chew  indigestible  objects,  as  rags,  leather,  straw,  feathers,  sticks,  and 
even  pieces  of  coal,  which  are  often  swallowed.  The  secretion  of 
saliva  in  some  cases  appears  to  be  excessive,  owing  to  the  inability 
to  swallow,  and  it  sometimes  becomes  frothy  from  the  champing  of 
the  jaws.  However,  foaming  at  the  mouth  is  not  a  constant  symp- 
tom of  rabies,  as  is  commonly  believed  by  the  layman;  and  further- 
more, it  is  frequently  misleading  owing  to  the  fact  that  it  may  be 
Dbserved  in  other  diseases.  The  erroneous  opinion  among  the  laity 
that  dogs  suffering  with  this  disease  are  afraid  of  water  is  also 
misleading,  since  such  dogs  have  been  known  to  swim  streams  in 
iheir  roamings.  On  the  other  hand,  they  appear  to  be  afraid  of 
lothing,  as  is  evidenced  by  attacking  all  animals  regardless  of  size. 

A  change  in  the  voice  of  the  animal  is  peculiar  to  this  affection, 
md  is  due  to  the  beginning  paralysis  of  the  throat,  which  usually 
;ets  in  early.  Instead  of  the  normal  bark  the  affected  dog  makes  a 
ong,  resonant,  peculiarly  drawn-out  bark  which  has  been  likened  to 
he  yelp  of  a  coyote.  Later,  as  the  paralysis  gradually  extends, 
)arking  and  swallowing  become  impossible,  although  attempts  may 
)e  made  to  swallow.  At  this  stage  the  muscles  of  the  jaw  become 
)araiyzed,  causing  the  lower  jaw  to  drop  and  the  tongue  to  hang 
)ut,  which  makes  it  collect  dirt  and  appear  dry  and  darker  in 
olor.  Owing  to  this  latter  symptom  the  disease  has  been  termed 
black  tongue  "  in  certain  sections.  Upon  closer  observation  the 
)upil  of  the  eye  is  frequently  found  to  be  dilated.  The  paralysis 
ontinues  to  extend,  the  hind  legs  become  involved,  and  the  dumb 
orm  of  the  disease  results.  Finally  death  follows  in  from  four  to 
ight  days  after  the  development  of  the  first  symptoms. 

DUMB   RABIES  IN  THE   DOG. 

The  dumb  or  paralytic  form  of  rabies  is  much  more  infrequent 
han  the  furious  type,  and  is  characterized  by  the  early  appearance 
f  paralysis  without  symptoms  of  frenzy  or  irritabilit}'  which  are 
88301°— Bull.  449—11 1 


10  RABIES   OR    HYDROPHOBIA. 

observed  in  the  early  stages  of  the  furious  form.  Therefore  the,^ 
animal  affected  with  this  type  of  the  disease  is  not  capable  of  doing  ^ 
much  damage.  Indeed  the  dog  is  much  depressed  from  the  begin- 
ning and  seeks  quiet  spots  or  hides  in  some  secluded  place.  Probably 
the  first  symptom  noted  by  the  owner  is  the  paralysis  of  the  lower 
jaw,  as  a  result  of  which  the  animal  is  often  suspected  of  having  a 
"  bone  in  its  throat."  The  paralysis  quickly  progresses  until  it 
involves  the  legs  and  trunk  and  results  in  death  in  from  one  to 
three  days. 

RABIES  IlSr  CATTLE. 

In  cattle  both  furious  and  dumb  rabies  are  met  with  as  in  dogs, 
the  former  being  the  more  common.  However,  a  sharp  line  of  dis- 
tinction can  not  always  be  drawn  between  these  two  forms  of  the 
disease,  as  the  furious  type  usually  merges  into  the  dumb,  due  to  the 
paralysis  which  always  appears  prior  to  death.  The  typical  cases 
of  dumb  rabies  are  those  where  the  paralysis  occurs  at  the  beginning 
of  the  attack  and  remains  until  the  death  of  the  animal.  The  disease 
first  manifests  itself  by  loss  of  appetite,  stopping  of  the  secretion 
of  milk,  great  restlessness,  anxiety,  manifestation  of  fear,  and  change 
in  the  disposition  of  the  animal.  This  preliminary  stage  is  followed 
in  a  day  or  two  by  the  stage  of  excitation  or  madness,  which  is  indi- 
cated by  increasing  restlessness,  loud  bellowing  with  a  peculiar  change 
in  the  sound  of  the  voice,  violent  butting  with  the  horns  and  pawing 
the  ground  with  the  feet,  with  an  insane  tendency  to  attack  other 
animals,  although  the  desire  to  bite  is  not  so  marked  in  cattle  as  in 
the  canine  race.  About  the  fourth  day  the  animal  usually  becomes 
quieter  and  the  walk  is  stiff,  unsteady,  and  swaying,  showing  that 
the  final  paralysis  is  coming  on.  Loss  of  flesh  is  extremely  rapid, 
and  even  during  the  short  course  of  the  disease  the  animal  becomes 
exceedingly  emaciated.  The  temperature  is  never  elevated,  but 
usually  remains  about  normal  or  even  subnormal.  Finally  there  is 
complete  paralysis  of  the  hind  quarters,  the  animal  being  unable  to 
rise,  and,  but  for  irregular  convulsive  movements,  lies  in  a  comatose 
condition  and  dies  usually  in  from  four  to  six  days  after  the  apjoear 
ance  of  the  first  symptoms. 

RABIES  IN  CATS. 

"When  the  disease  attacks  cats,  these  animals  generally  hide  them- 
selves under  the  furniture  or  in  some  dark  hidden  corner,  and  there 
they  may  die  unobserved  in  the  course  of  a  day  or  two.  As  a  rule, 
however,  the  disease  implies  danger  for  human  beings.  The  rabid 
cat  becomes  very  bellicose;  from  the  dark  corner  where  it  has  hidden 
itself  it  will  suddenl}'  attack  animals  or  persons,  and  especiall}-  when 

449 


EABIES    OE   HYDEOPHOBIA.  11 

children  are  involved  it  will  jump  up  to  the  face  and  inflict  severe 
wounds  with  its  teeth  and  claws.  In  the  violence  of  this  attack  it 
frequently  bites  itself.  The  rabid  cat  loses  its  voice,  being  able  only 
to  mew  hoarsely.  Later  it  loses  its  appetite,  has  difficulty  in  swal- 
lowing, becomes  emaciated,  and  succumbs  within  several  days  with 
symptoms  of  paralj'sis. 

Horses,  sheep,  goats,  hogs,  chickens,  and  animals  of  prey  such  as 
wolves,  foxes,  badgers,  and  martens  also  contract  rabies  when  bitten 
b}"  rabid  animals,  and  behave  quite  similarly  to  rabid  dogs,  cattle, 
and  cats. 

POST-MORTEM  APPEAEANCES. 

In  rabies  there  are  no  constant  or  definite  lesions  observed  on  post- 
mortem examination  of  the  carcass.  In  fact,  the  alterations  are 
slight,  variable,  and  almost  absent  at  times,  so  that  unless  there  is  a 
good  historj^  or  characteristic  symptoms  a  positive  diagnosis  can  not 
be  made  without  recourse  to  microscopic  examination  or  animal 
inoculations  of  the  brain  of  the  suspected  animal.  The  most  sug- 
gestive indication  of  rabies  is  the  presence  in  the  stomach  of  unusual 
bodies  such  as  stones,  wood,  earth,  cloth,  iron,  feathers,  etc.  Fre- 
jquently  the  stomach  is  empty  of  food,  but  distended  with  material 
of  this  character.  Its  mucous  membrane  is  frequently  injected,  and 
at  times  a  marked  reddening  of  the  folds  of  the  stomach,  with  or 
without  erosions,  is  noticed.  There  may  also  be  an  inflammation  of 
;the  covering  of  the  brain  and  cord  as  well  as  of  the  mucous  lining  of 
the  mouth,  throat,  and  respiratory  tract.  The  feet  of  rabid  dogs 
may  present  sores  and  bruises,  denoting  extensive  travel  which  had 
been  accomplished  during  the  period  of  roving.  The  heart  and  peri- 
cardium are  often  inflamed,  but  these  and  similar  lesions  are  more 
frequently  due  to  the  condition  of  the  animal  before  dying  than  to 
any  specific  alteration.    The  carcass  rapidly  undergoes  decomposition. 

TRANSMISSION  OF  THE  DISEASE  BY  MILK  AND  MEAT. 

While  the  virus  of  rabies  is  most  frequently  found  in  the  central 
nervous  system  and  the  salivary  glands,  it  may  also  be  found  in 
other  glands  and  secretions,  including  the  mammary  glands  and 
the  milk.  That  rabies  may  at  times  be  excreted  with  the  milk  has 
been  proved  by  IN'ocard,  Perroncito,  Bardach,  and  the  writer.  In 
these  latter  experiments  the  milk  of  a  rabid  bitch  having  a  litter  of 
puppies  was  inoculated  intramuscularly  into  rabbits  and  guinea  pigs, 
and  produced  typical  rabies;  but  the  puppies,  removed  from  the 
mother  when  the  first  symptoms  developed,  were  kept  under  observa- 
tion for  18  months  without  developing  the  disease.  The  reason 
for  these  negative  results  in  the  puppies  may  be  explained  (1)  by  not 

449 


12  EABIES   OR   HYDROPHOBIA. 

having  been  bitten  bv  the  mother  before  she  was  removed,  and  (2)  the 
absence  of  any  abrasion  in  the  alimentary  tract  through  which  the 
virus  could  have  entered  the  circulation. 

It  is  a  generally  accejoted  fact  that  rabies  can  not  be  transmitted  to 
normal  animals  through  food  containing  the  virus  of  the  disease 
unless  lesions  are  present  in  the  alimentary  canal;  but  the  conclusion 
that  there  is  no  danger  to  the  consumer  from  the  meat  or  milk  of 
animals  that  are  rabid  is  not  tenable,  since  abrasions  of  the  lips, 
mouth,  and  pharj'nx  are  all  too  frequent  to  permit  of  such  risks. 
These  products  must  therefore  be  considered  as  dangerous  to  health. 

One  case  is  on  record  where  a  bab}'  in  Cuba  developed  rabies  from 
nursing  its  mother  while  the  latter  was  in  the  early  stages  of  hydro- 
phobia. In  this  case,  however,  the  virus  in  the  milk  raaj  have 
entered  the  circulation  through  abrasions  of  the  gums  during  teeth- 
ing. Similar  cases  have  been  reported  in  veterinar3^  practice  where 
the  virus  of  rabies  was  observed  to  have  been  passed  to  the  offspring 
through  the  mother's  milk,  but  in  these  cases  it  is  impossible  to 
elimmate  an  obscure  bite  from  the  bitch  or  lesions  of  the  gums  dur- 
ing this  early  age.  TSTiile  it  is  not  probable  that  cattle  would  be 
milked  after  the  symptoms  of  rabi&s  developed,  it  is  nevertheless 
important  to  realize  the  danger  of  using  such  milk  and  the  necessity 
for  presenting  calves  from  sucking  such  diseased  cows. 

All  attempts  to  convey  the  disease  to  healthy  dogs  by  feeding  them 
upon  meat  from  infected  animals  have  given  negative  results.^ 
Xevertheless  the  meat  of  rabid  animals  must  l^e  considered  as  unfit 
for  food,  and  the  meat-inspection  regulations  enforced  by  the  various 
countries  having  such  inspection  provide  for  the  total  condemnation 
of  the  carcasses  of  these  animals. 

Infection  has  occurred  in  man  from  making  autopsies  on  rabid 
dogs,  and  it  is  likewise  possible  to  result  if  inoculation  occurs  while 
handling  the  meat  of  rabid  cattle,  hogs,  or  sheep.  Ostertag  reports 
the  case  of  a  veterinarj^  student  at  Copenhagen  who  infected  a  wound 
on  his  finger  while  making  an  autoj^s}^  on  a  dog  dead  of  rabies  and 
died  of  the  disease.  Another  somewhat  similar  case  occurred  in  a 
veterinary  student  at  Dresden  in  consequence  of  an  injury  received 
while  holding  a  post-mortem  on  a  rabid  dog. 

Wyrsykowski.  in  an  attempt  to  discover  the  reason  for  the  fact  that 
no  illness  followed  the  eating  of  the  meat  and  even  the  brain  of  rabid 
animals,  tested  the  action  of  the  gastric  juice  upon  infectious  material 
in  vitro.  Twenty-one  rabbits  were  inoculated  with  this  artificially 
dig-ested  virus,  but  not  one  animal  contracted  the  disease,  while  all  the 


*  Claudio  Fermi'  has  recently  produced  rabies  in  rats  and  mice  by  feedinj:?  them  rabietic, 
material  with  their  food.      About  60  per  cent  of  the  70  animals  so  fed  died  of  paralyti 
rabies. 

440 


1 


EABIES    OR   HYDROPHOBIA.  13 

17  check  rabbits  which  were  inoculated  with  undigested  rabies  virus 
developed  the  disease  and  died.  It  is  evident,  therefore,  that  the 
gastric  juice  has  a  pronounced  deleterious  effect  ujDon  the  virus  of 
rabies. 

DIFFERENTIAL  DIAGNOSIS. 

The  present  advocates  of  the  assumption  that,  rabies  is  a  disease  of 
phe  imagination  should  be  better  fortified  in  both  their  facts  and  their 
heory.  Little  children  certainly  do  not  die  after  a  dog  bite  from  the 
effects  on  the  imagination,  nor  do  horses,  cattle,  sheep,  hogs,  dogs, 
'abbits,  and  monkeys  die  from  an  imaginary  disease.  It  must  be 
nore  than  a  mere  coincidence  that  ever  since  the  recognition  of  this 
lisease  in  the  days  of  Aristotle  this  peculiar  mode  of  death  has 
occurred  only  after  infection  by  a  rabid  animal.  The  daily  news- 
)apers  may  add  to  the  sensational  details  of  these  occurrences,  but 
here  is  no  doubt  of  the  real  danger  involved. 

Anyone  who  has  seen  the  suffering  of  one  human  being  affected 
v'ith  this  fatal  disease  will  readily  concede  that  no  amount  of  incon- 
enience  caused  animals  by  muzzling  or  other  protective  arrange- 
iient  can  ever  be  considered  too  much  to  prevent  such  suffering,  nor 
hould  it  prove  difficult  to  differentiate  between  hydrophobia  and 
he  pseudo  form,  which  has  been  termed  lyssophobia,  if  all  the  cases 
'f  these  diseases  were  as  typical  as  the  two  which  were  brought  to 
lie  writer's  attention. 

Through  the  courtesy  of  Dr.  "William  C.  Woodward,  health  officer 
f  the  District  of  Columbia,  I  Avas  invited  to  visit  Freedmen's  Hos- 
dtal  for  the  purpose  of  seeing  a  patient  whose  case  had  been  diag- 
osed  b}^  the  resident  surgeon  as  suspected  hydrophobia.  The  woman, 
8  years  of  age,  had  been  fiercely  attacked  and  severely  bitten  on  the 
ight  forearm  and  about  the  face  by  a  stray  collie  dog.  Eighteen 
ays  later  she  complained  of  a  general  malaise  and  pains  in  the  cica- 
pized  wounds  of  the  head,  which  rapidly  grew  more  severe,  necessi- 
iting  the  services  of  a  physician,  upon  whose  advice  the  patient  was 
3moved  to  the  hospital  on  the  following  day.  My  visit  occurred  on 
le  afternoon  of  the  succeeding  day,  at  which  time  the  patient  was 
Dund  in  an  extremely  nervous  condition,  having  an  excessive  feel- 
ig  of  fear  and  uneasiness.  The  eyes  were  staring  and  a  general 
s:pression  of  anxiety  pervaded  her  countenance.  Her  mind  was 
^ear,  and  no  efforts  at  violence  were  made.  A'^Tien  interviewed  as  to 
le  scars  on  her  head  and  forearm  she  lightly  replied.  "  Oh,  a  dog 
it  me  there  some  weeks  ago,  but  they  are  all  right  now." 
From  time  to  time  reflex  spasms  involving  the  muscles  of  deglu- 
tion  were  noticed,  causing  a  clutching  at  the  throat  and  difficult 
reathing  during  the  attack.  These  rapidly  became  more  general- 
;ed  and  soon  involved  the  respiratory  muscles,  causing  dyspnea. 

449 


14  EABIES   OR   HYDROrHOBIA. 

Attempts  at  vomiting  ttouIcI  then  occur,  but  no  evacuations  followed 
Contrary'  to  the  views  of  our  skeptical  friends,  the  patient  accredited 
these  symptoms  to  indigestion,  and  had  not  the  slightest  suspicion  of 
the  true  nature  of  her  condition,  thus  disproving  the  idea  that  the 
nervousness  and  fear  usually  seen  in  the  early  stages  of  rabies  in 
the  human  subject  are  due  to  the  natural  dread  of  the  disease  and 
apprehension  of  the*  consequences  rather  than  to  organic  changes  in 
the  central  nervous  system.  During  the  night  these  s3anptoms  be- 
came more  aggravated  and  spasms  followed  one  another  more  rapidlj'^, 
causing  grave  delirium.  The  patient  finally  became  violent,  requir- 
ing the  adoption  of  forcible  measures  to  keep  her  under  control. 
Death  occurred  on  the  following  morning,  21  days  after  the  bites  had 
been  inflicted.  On  post-mortem  examination  no  pathological  lesions 
were  found  which  could  be  held  accountable  for  the  symptoms  which 
resulted  in  death,  but  histological  examinations  of  the  plexiform 
ganglia  and  the  medulla,  as  well  as  the  inoculation  of  rabbits,  both 
subdurally  and  intramuscularly,  with  an  emulsion  of  the  brain,  re 
suited  in  the  confirmation  of  the  diagnosis  of  hydrophobia. 

That  the  appearance  of  a  disease  like  rabies  in  a  community  seemsj 
peculiarly  and  in  an  extraordinary  degree  to  be  associated  with  an' 
atmosphere  of  hysterical  simulation  and  to  inspire  states  of  auto- 
suggestion must  be  admitted.  One  case  of  this  character  recently 
came  to  my  attention  through  the  kindness  of  a  local  phj^sician  which 
is  in  direct  contrast  to  the  instance  cited  above. 

A  young  man,  24  years  of  age,  employed  as  a  clerk  in  a  drj  goods 
store,  was  bitten  on  a  Saturday  morning  by  a  watchdog  belonging 
to  the  proprietor.  The  bite,  which  was  slight,  had  been  immediately 
cauterized,  and  no  further  attention  was  given  to  the  incident  until 
Wednesday  morning,  when  the  young  man  fainted  at  the  counter. 
Upon  reviving  he  stated  that  he  had  been  reading  about  rabies  and 
the  symptoins  which  would  develop  in  man  from  the  bite  of  a  rabid 
dog,  and  insisted  that  he  was  developing  hydrox^hobia  as  a  result  of 
having  been  bitten  by  the  watchdog.  He  was  immediately  sent  to; 
his  home  and  the  dog  brought  to  the  bureau  to  be  kept  under  obser- 
vation. Two  days  later  the  young  man  was  in  a  very  hysterical  state 
and  kept  insisting  that  the  dog  that  bit  him  was  rabid.  During  this 
time  the  patient  had  been  in  bed,  and  seemed  to  have  had  marked 
IDaroxysms.  He  would  roll  himself  over  and  over  in  bed,  snarling, 
growling,  and  snapping  at  the  bed  clothes.  He  would  catch  the  pil- 
low or  sheet  with  his  teeth  and  shake  it  like  a  terrier  shaking  a  rat, 
and  in  numerous  other  ways  would  show  more  imitative  accuracy  than 
in  the  genuine  disease.  At  first  it  was  impossible  to  attract  his  atteji- 
tion,  although  he  would  mutter  and  talk  to  himself,  "\^^len  he  was 
informed  that  the  dog  that  bit  him  did  not  have  rabies,  that  it  was 

44ft 


BABIES    OR   HYDROPHOBIA.  15 

ilive  and  well,  and  tliat  even  if  it  did  develop  rabies  several  weeks 
ater  it  would  have  no  bearing  on  his  case,  as  the  saliva  would  not  be 
7-irulent  such  a  long  period  before  the  development  of  the  symptoms 
n  the  dog,  and  furthermore  that  he  had  developed  symptoms  entirely 
,00  soon  after  the  bite  had  been  inflicted,  as  a  longer  period  of  incuba- 
ion  had  to  intervene  for  the  virus  to  multiply  and  produce  its  effects, 
16  commenced  to  realize  that  he  had  been  making  himself  a  victim  of 
autosuggestion,  and  rapid  recovery  followed. 

Here  was  a  typical  case  of  lyssophobia  or  pseudo-rabies,  a  figment 
if  an  overworked  imagination,  and,  as  in  all  cases  of  this  class,  re- 
overy  took  place  instead  of  death,  which  is  always  the  termination 
f  the  true  disease. 

It  has  been  stated  b}^  certain  physicians  that  tetanus  (lockjaw)  is 
mdoubtedl}^  the  true  cause  of  death  in  the  majority  of  instances  where 
abies  has  been  diagnosed.  It  is  not  my  purpose  to  give  a  differential 
iagnosis  between  these  two  diseases  in  man,  but  there  is  such  a 
larked  difference  between  a  horse  affected  with  tetanus  and  one  with 
abies,  or  a  cow  affected  with  tetanus  and  one  with  rabies,  or  a  dog 
ffected  with  tetanus  and  one  with  rabies,  that  a  few  brief  words  on 
ifferential  characteristics  will  be  given. 

Tetanus  may  be  readily  differentiated  from  rabies  by  the  per- 
istence  of  muscular  cramps,  especially  of  the  neck  and  abdomen, 

hich  cause  these  muscles  to  become  set  and  hard  as  wood.  In 
itanus  there  is  also  an  absence  of  a  depraved  appetite  or  of  a  will- 
ul  propensity  to  hurt  other  animals  or  damage  the  surroundings, 
'he  general  muscular  contraction  gives  the  animal  a  rigid  appear- 
nce,  and  there  is  an  absence  of  paralysis  which  marks  the  advanced 
'age  of  rabies.  The  dumb  form  of  rabies  in  dogs  is  characterized 
y  a  paralysis  and  pendency  of  the  lower  jaw,  while  in  tetanus  the 
iws  are  locked.  This  locking  of  the  jaws  in  horses  is  very  charac- 
iristic,  and  in  cattle  or  dogs  it  renders  the  animals  incapable  of  bel- 
)wing  or  barking  as  in  rabies.  Finally,  tetanus  may  be  distinguished 
fom  rabies  by  the  fact  that  the  central  nervous  system  does  not  con- 
lin  the  infectious  principle,  while  in  rabies  the  inoculation  of  test 
aimals  with  the  brain  or  cord  of  a  rabid  animal  will  produce  the 
isease  with  characteristic  symptoms  after  an  interval  of  15  to  20 
ays.  This  period  of  incubation  is  much  longer  than  in  tetanus, 
nee  the  inoculation  of  rabbits  with  tetanus  bacilli  invariably  results 
I  death  aft-er  a  short  period,  usually  within  3  or  4  days. 

DISTRIBUTION  AND  PREVALENCE. 

There  is  no  intention  of  assuming  the  part  of  an  alarmist  with 
iference  to  the  increasing  prevalence  of  rabies.  It  can  not  be  denied, 
Dwever,  that  there  is  at  present  unusual  occasion  for  alarm  in  certain 

440 


16  BABIES   OE.  HYDEOPHOBIA. 

parts  of  this  country.  It  may  be  true  that  many  newspaper  stories 
have  been  exaggerated  or  are  entirel}^  false,  but  it  is  not  true  thai 
all  are  fabrications.  This  is  shown  by  a  number  of  cases  traced  bj 
the  writer  where  the  diagnosis  had  been  made  m  reputable  labora 
tories  by  recognized  scientists.  Kerr  and  Stimson  in  their  invest! 
gation  of  the  prevalence  of  rabies  used  a  number  of  press  clippings 
and  in  no  instance  did  a  press  report  lack  official  confirmation,  which 
is  quite  contrary  to  the  general  opinion  on  this  subject. 


IN  THE  UNITED  STATES. 


In    looking    over    the    proceedings    of   the    American    Veterinary 
Medical  Association  for  the  past  12  years,  it  was  observed  that  rabies 
is  reported  as  existing  in  a  number  of  States  each  year,  although 
there  has  been  no  special  endeavor  on  the  part  of  the  resident  State 
secretaries  to  ascertain  the  extent  of  this  particular  disease  in  their 
sections.     Tn  1897  the  disease  was  reported  in  4  States,  in  1898  in 
5  States,  while  in  1899  the  statement  of  Huidekoper  was  cited  by 
Parker  to  the  effect  that  the  disease  was  not  west  of  the  Rockies  aiid 
was  rare  in  the  United  States  except  in  Pennsylvania  and  Massa 
chusetts.    However,  in  the  1900  report  we  find  that  the  disease  had 
appeared  in  Montana,  Wyoming,  and  Colorado,  in  addition  to  cer- 
tain Eastern  and  Central  Western  States.     It  is  evident  from  the 
succeeding  reports  that  the  disease  was  becoming  more  widespread 
and  at  the  meeting  of  the  American  Veterinary  Medical  Association 
in  Philadelphia  in  1908,  of  the  20  resident  State  secretaries  who 
reported,  13  incidentally  mentioned  the  existence  of  rabies  in  their 
States,   and   in    Alabama,    Connecticut,   the   District   of   Columbia^ 
Minnesota,  Mississippi,  and  Ohio  the  disease  seemed  to  be  on  tha 
increase.     As  there  was  no  apparent  reason  for  mentioning  the  pres- 
ence or  absence  of  this  disease,  the  failure  of  the  reports  from  the 
remaining  7  States  to  refer  to  rabies  should  not  be  considered  as 
indicative  of  its  absence.    In  fact,  the  writer  has  corresponded  witb 
officials  in  these  7  States,  and  replies  have  been  received  from  5  oi 
them  to  the  effect  that  rabies  had  prevailed  in  their  localities  during 
1908,  thus  showing  that  the  disease  existed  in  18  of  the  20  States 
mentioned  in  the  1908  report.     We  have  gone  even  further  in  oufl 
correspondence   and  have  endeavored   to  find  out  if  there   is   any 
State  or  Territory  in  the  United  States  where  rabies  is  unknown.! 
From  the  information  at  the  writer's  disposal  it  would  appear  that 
the  disease  occurs  in  almost  every  State  in  the  Union,  and  the  onlyj 
places  where  it  has  been  impossible  to  obtain  positive  information) 
are  Idaho,  Utah,  Nevada,  and  Oregon,^  while  in  the  State  of  Wash-i 


I  Rabies  has  been  reported  in  Oregon  by  Pcrnot  since  this  paper  was  written. 
449 


I 


KABIES   OR   HYDROPHOBIA. 


17 


ngton  there  has  been  but  one  outbreak,  which  was  quickly  sup- 
)ressed  7  years  ago.  It  would  be  entirely  impracticable  without 
egistration  laws  to  ascertain  the  extent  of  the  disease  among  ani- 
aals  in  the  various  infected  sections,  but  the  disease  appears  at 
imes  in  certain  centers  with  all  the  vigor  of  an  enzootic,  and  such 
utbreaks  have  occurred  recently  in  Jacksonville,  Fla. ;  El  Paso,  Tex. ; 
Norfolk,  Va.;  Kansas  City,  Mo.;  Boston,  Mass.;  Chicago,  111.;  Bal- 
imore,  Md. ;  Washington,  D.  C. ;  Cleveland,  Ohio ;  Pasadena  and 
jOS  Angeles,  Cal. ;  and  certain  sections  of  New  York,  Pennsylvania, 
linnesota,  Ohio,  Missouri,  and  Michigan.  Not  only  is  there  a 
radual  increase  in  the  number  of  outbreaks  of  rabies,  but  many  new 
ienters  which  appear  to  be  more  or  less  permanent  are  being  estab- 
shed  from  year  to  year.  The  fiscal  year  1909  is  the  first  year  when 
ver  100  cases  of  rabies  have  been  diagnosed  in  the  Pathological 
Hvision  of  the  Bureau  of  Animal  Industry,  and  of  the  positive 
ases,  79  came  from  the  District  of  Columbia  and  33  were  divided 
mong  Virginia,  Maryland,  West  Virginia,  and  South  Carolina. 
The  following  table,  prepared  by  Kerr  and  Stimson,  of  the  United 
tates  Public  Health  and  Marine-Hospital  Service,  gives  a  partial 
st  of  the  number  of  laboratory  diagnoses  of  rabies  found  in  1908 
t  the  various  institutions  interested  in  the  investigation  of  this  dis- 
ise.  They  call  attention  to  the  fact  that  these  figures  represent  in 
lany  instances  only  a  small  proportion  of  the  actual  number  of  cases 
f  rabies  occurring  in  the  various  States.  For  example,  while  only 
7  cases  of  rabies  have  been  actually  demonstrated  in  Wisconsin,  the 
tate  veterinarian  estimates  that  584  animals  died  of  this  disease 
iiring  1908. 

Positive  findings  of  rahies  in  animals,  190S. 


Diagnosis  made  by— 


li 
;laware  State  Board  of  Health  laboratory. . . 
nnecticut  State  Board  of  Health  laboratory. 

orida  State  Board  of  Health  laboratory 

liana  University,  Bloomington,  Ind 

liana  State  Board  of  Health  lalwratory 

Itimore  (Md.)  Pasteur  Institute 

•ssachusetts  cattle  bureau 

liversity  of  Michigan  Pasteur  Institute 

w  Harripshire  State  Board  of  Health 

w  Jersey  State  Board  of  Health 

w  York  Pasteur  lastitute 

•rth  Carolina  State  laboratory  of  hygiene 

rmont  State  Board  of  Health 

iscoDsin  state  hygienic  laboratory " 

w  YorkState  Veterinary  College 

anesota  State  li ve-stoclv  board 

'.reau  of  Animal  Industry,  Pathological  Division,  Washington,  D.  C . 

iveland  health  department,  east  side 

nnsyl vania  State  live-stock  sanitary  board 

io  State  Board  of  Health  laboratories 

■ginia  Pasteur  Institute,  Richmond 

^logical  laboratories,  Brown  University,  Providence,  R.I 

Total 


449 


Number. 


7 
14 
20 
12 
75 
74 

135 

101 
7 
13 
60 
21 
2 
47 

188 
15 

121 
49 

103 
32 
39 
32 

1,167 


18  EABIES   OR   HYDROPHOBIA. 

In  a  letter  from  former  State  Veterinarian  Langley  he  states  tlia 
Texas  j^robably  has  more  rabies  than  any  other  State  in  the  Union 
Se^^eral  j^ears  ago  President  Frank  Wells,  of  the  Michigan  Stat( 
Board  of  Health,  made  rabies  largely  the  subject  of  his  annual  ad 
dress  and  declared  it  was  epidemic  in  Michigan.  Vaughan,  who  re 
ported  as  a  special  committee  on  rabies,  intimated  that  it  had  gradj 
ually  spread  from  New  York,  where  it  had  prevailed  for  a  number  o: 
years  previously,  into  Ohio  and  thence  to  Michigan,  having  been  dif 
fused  throughout  the  Lower  Peninsula  of  Michigan,  In  fact,  th(' 
disease  became  so  widespread  and  so  many  people  were  bitten  that  th( 
State  appropriated  funds  for  the  establishment  of  a  Pasteur  institut< 
in  connection  with  the  medical  department  of  the  University  of  Michi 
gan.  A  Pasteur  institute  was  likewise  established  in  April,  1908,  ir 
Washington,  D.  C.,  in  connection  with  the  Hj^gienic  Laboratory  of  th(' '' 
United  States  Public  Health  and  Marine-Hospital  Service,  owing  t( 
the  continued  outbreak  of  rabies  in  that  vicinit}''  and  the  large  numbeif 
of  people  bitten  hj  rabid  animals,  139  persons  having  been  treated 
since  its  establishment.  In  addition,  there  are  18  other  Pasteur  insti- 
tutes in  the  United  States,  located  at  Atlanta,  Ga. ;  Austin,  Tex. 
Baltimore,  Mel. ;  Chicago,  111. ;  Iowa  City,  Iowa ;  Jacksonville,  Fla. 
Minneapolis,  Minn.;  Montgomery,  Ala.;  Newark,  Del.;  New  Or 
leans,  La. ;  Pittsburg,  Pa. ;  Ealeigh,  N.  C. ;  Richmond,  Va. ;  St.  Louis, 
Mo. ;  two  in  Indianapolis,  Ind. ;  and  two  in  New  York  City. 

As  an  indication  of  both  the  distribution  and  the  prevalence  oi  *' 
rabies  among  animals  may  be  considered  the  number  of  persons  whc  'i 
have  been  treated  at  these  institutes.    The  directors  of  these  Pasteui"' 
institutes  have  been  requested  to  furnish  this  information,  and  the' Si 
majority  have  responded.     From  these  reports   it   is  evident  thaff 
several  thousand  people  have  been  subjected  to  the  Pasteur  treatmeni  ^ 
recently,  and  hundreds   (nearly  1,500  persons  in  1908)    receive  the 
treatment  every  year  as  a  result  of  bites  inflicted  by  rabid  animals, 
At  the  Pittsburg  institute  1,022  persons  from  Canada,  Ohio,  Pennsyl 
vania,  New  York,  West  Virginia,  and  Colorado  have  received  treat- 
ment, as  follows :  3i 

From  December,  1900,  to  September,  1902,  76  cases.  * 

From  October,  1902,  to  October,  1904,  143  cases. 
From  October,  1904,  to  October,  1906,  185  cases. 
From  October,  1906,  to  October,  1908,  368  cases. 
From  October,  1908,  to  June,  1909,  250  cases. 

The  Texas  institute,  under  State  control,  has  been  established  less 
than   5  years,  but  the  number  of   persons  who  have   applied   for 
treatment  has  gi-adually  increased  from  81  in  1905  to  254  in  1906,  SlOf 
in  1907,  and  353  in  1908,  these  patients  coming  from  7  Southwestern 
States  and  old  Mexico. 

449 


E 


ti 


Ji 


BABIES    OR  HYDROPHOBIA.  19 

At  the  St.  Louis  institute  381  persons  have  been  treated,  coming 
icrom  11  Southern  and  Central  Western  States  and  from  Mexico. 
j    Since  1890  the  Chicago  institute  has  treated  3,016  people,  coming 
:rom  30  different  States  of  the  Union. 

At  the  New  York  institute  (Rambaud's)  1,367  cases  were  treated 
between  1880  and  1900,  237  cases  in  1900  and  1901,  and  486  cases 
Tom  October,  1904,  to  October,  1906. 

Brawner,  of  the  Georgia  institute,  has  treated  670  patients  since 
■900,  with  only  2  deaths.  During  this  time  all  the  people  in  Georgia 
)itten  hj  rabid  animals  so  far  as  could  be  learned,  and  who  did  not 
ake  the  treatment,  were  recorded,  and  of  the  120  bitten  without  sub- 
equent  treatment  29  have  died.  Rabies  is  said  to  be  very  much  on 
he  increase  in  that  section,  and  it  is  not  uncommon  for  farmers  to 
ose  many  horses,  cows,  and  hogs  from  the  disease. 

At  the  Baltimore  institute  1,092  cases  have  been  treated,  334  of 
?^hich  came  from  Maryland,  117  from  North  Carolina,  102  from  Penn- 
ylvania,  104  from  Virginia,  112  from  West  Virginia,  57  from  the 
district  of  Columbia,  and  the  remainder  from  13  other  States. 

Since  1901  the  Richmond  institute  has  treated  208  cases,  coming 
rom  Virginia,  North  and  South  Carolina,  and  West  Virginia. 

As  a  further  indication  of  the  number  of  persons  bitten  but  who 
lid  not  take  the  Pasteur  treatment  are  the  census  reports  showing 
he  mortality  statistics  from  rabies.  In  the  census  of  1900,  when  only 
bout  40  per  cent  of  the  population  resided  in  districts  where  registra- 
ion  was  observed,  123  deaths  from  rabies  distributed  in  20  States 
(^ere  reported.  That  this  number  was  entirely  too  low  was  shown  by 
Jalmon  in  1900,  who  corresponded  with  a  number  of  health  officers 
rithin  and  without  the  registration  districts  and  collected  230  authen- 
Lc  cases  of  hydrophobia  in  man  during  this  same  interval  in  73  cities. 

That  the  increase  of  rabies  in  animals  which  has  been  demonstrated 
bove  bears  a  direct  relation  to  the  increase  in  the  disease  in  man  is 
hown  by  the  vital  statistics  of  the  Census  Bureau,  as  follows : 

In  1903,  43  people  died  of  rabies ;  in  1904,  38 ;  in  1905,  44 ;  in  1906, 
5 ;  in  1907,  75 ;  in  1908,  82.  These  deaths  occurred  only  in  the  regis- 
ration  area  of  the  United  States,  which  now  includes  about  51  per 
ent  of  the  total  population. 

IN   OTHER   COITNTIIIES. 

While  the  disease  in  certain  foreign  countries  has  at  times  appeared 
1  the  form  if  severe  enzootics  extending  over  considerable  territory, 
1  the  course  of  the  last  decade  the  affection  has  decreased  on  the 
hole,  and  in  some  places  has  even  disappeared  entirely,  owing  to  the 
Igid  enforcement  of  muzzling  and  quarantine  regulations.  Accor^l- 
ig  to  Tlutyra  and  Marek  the  disease  in  France  is  widely  distributed 

449 


20  BABIES   OR   HYDEOPHOBIA. 

all  over  the  country.  Since  1899  more  than  2,000  cases  of  rabies  in  | 
animals  have  been  reported  each  year,  and  in  1903  there  were  2,391 
rabid  animals.  In  Germany  during  the  years  1895  to  1898  the  num- 
ber of  cases  of  rabies  increased  rapidly  from  489  to  1,202.  The 
number  then  decreased  to  612  in  1902.  These  cases  occurred  mainly 
in  the  eastern  and  southern  provinces  bordering  on  the  badly  infected 
districts  in  Russia  and  Austria,  while  in  the  other  parts  of  Germany 
only  a  few  isolated  outbreaks  of  the  disease  appeared.  In  Austria 
the  disease  has  been  on  the  increase  since  1891,  and  in  1900  there  vvere 
1.187  cases  reported.  During  this  interval — from  1891  to  1900 — 4,974 
people  were  bitten  by  rabid  animals,  123  or  2.4  per  cent  of  whom 
died  of  hydrophobia.  In  1903  the  number  of  people  bitten  by  mad 
dogs  varied  from  11  to  42  weekly.  In  Hungar}^  there  was  a  momen- 
tous decrease  in  rabies  following  the  passage  of  the  veterinar}'  sani- 
tary law  of  1888,  but  since  1893,  when  there  were  883  cases,  outbreaks 
have  been  gradually  increasing,  and  in  1903,  2,040  rabid  animals  were 
reported.  The  disease  is  most  common  in  Russia,  and  it  also  appears 
very  frequently  in  Roumania,  Servia,  and  Bulgaria.  In  Turkey, 
despite  the  large  number  of  dogs,  the  disease  does  not  increase  much, 
which  is  explained  by  Remlinger  by  the  fact  that  the  af!ection  gen- 
erally appears  in  the  form  of  dumb  rabies.  In  1903  only  35  rabid 
animals  were  reported  in  Belgium,  25  in  Holland,  18  in  Switzerland, 
and  376  in  Italy.  Spain  has  had  more  frequent  outbreaks  of  the 
disease,  while  Denmark,  Sweden,  and  especially  Norway  and  Great 
Britain,  have  beer,  free  from  the  contagion  for  several  3'ears  owing  to 
the  wise  provision  that  all  dogs  running  at  large  shall  be  muzzled. 
The  islands  of  Australia,  Tasmania,  New  Zealand,  St.  Helena,  and 
the  Azores  have  never  become  infected  with  rabies,  and  the  first  three 
prevent  its  introduction  by  rigid  inspection  and  quarantine.  In  1905 
Rutherford  reported  the  disease  to  be  spreading  in  Canada,  and  in 
1908  Dudley  made  a  similar  statement  for  the  Philippine  Islands, 
where  the  malady  had  been  found  to  exist  in  39  jjrovinces.  The  latter 
recommends  the  establishment  of  a  Pasteur  institute  in  the  islands. 
That  rabies  is  increasing  in  Mexico  is  shown  by  the  report  of  the 
Pasteur  institute  in  the  City  of  Mexico.  For  the  20  years  since  this 
institute  was  established  8,680  patients  from  all  the  Federal  States  of 
Mexico  have  taken  treatment,  4,579  of  these  people  receiving  the  treat- 
ment during  the  last  six  years.  The  disease  is  also  known  to  occur 
at  infrequent  intervals  in  certain  sections  of  South  America,  Africa, 
and  Asia. 

PREVENTION    AND    ERADICATION. 

Sanitary  regulations  which  seek  to  control  the  disease  effectively 
by  exterminating  it  among  dogs  are  most  likely  to  prove  successful. 
There  is  no  communicable  disease  which  is  more  easily  prevented  or 

440 


BABIES    OR   HYDROPHOBIA.  21 

jradicated  than  rabies.  Since  the  infection  is  practically  alwaj-s  trans- 
mitted by  a  bite,  and  since  the  animal  which  does  the  biting  is  almost 
ahva^^s  a  dog,  all  sanitary-  measures  must  be  directed  to  the  control 
of  the;Ee  animals  for  a  snfficient  time  to  cover  the  incubation  period 
of  the  disease.  It  seems  inexcusable,  therefore,  to  allow  this  contagion 
to  be  propagated  indefinitely,  causing  untold  suffering  to  the  affected 
animals  and  menacing  the  lives  of  persons,  particularly  children,  who 
go  upon  the  streets. 

The  only  measures  necessary  to  obtain  the  desired  result  are  (1) 
a  tax  or  license  for  all  dogs,  with  a  fee  of  $2  for  males  and  $5  for 
females,  and  the  destruction  of  homeless  or  vagrant  dogs;  (2) 
restraint  of  all  dogs  which  appear  in  public  places,  either  by  the  use 
of  a  leash  or  an  efficient  muzzle. 

DOG   LICENSE.  , 

There  is  no  doubt  that  neglect  has  allowed  the  accumulation  of 
Dwnerless  dogs  in  this  countr}'  to  an  extent  that  renders  our  large  cities 
frequently  liable  to  incursions  of  rabid  animals.  To  even  mention 
muzzling,  however,  is  sufficient  to  bring  tirades  of  abuse  upon  the 
tiead  of  the  sanitarian,  and  dog  sentimentalists  are  immediately  up  in 
arms,  using  time,  influence,  and  money  to  prevent  such  an  ordinance. 
In  spite  of  the  obloquy  with  which  it  is  received  by  a  certain  mistaken 

lass  of  the  community,  the  results  of  muzzling  amply  justify  its 
recommendation,  and  its  rigid  enforcement  without  any  additional 
requirement  will  exterminate  rabies  in  a  district  in  a  shorter  time  than 
any  other  known  method.  Even  Dulles,  the  great  controversialist  on 
rabies,  admits  that  he  considers  muzzling  to  be  the  most  important 
measure  for  limiting  the  ravages  of  this  disorder,  no  matter  on  what 
theory  it  may  be  accounted  for.  Excellent  examples  of  its  efficiency 
are  shown  by  the  well-known  results  obtained  in  eradicating  the 
disease    from    England,    Sweden,    Denmark,    Berlin,    and    in    other 

ommunities. 

NECESSITY  FOR  MUZZLING. 

The  striking  results  obtained  by  England  have  caused  many  persons 
to  propose  and  advocate  a  national  dog  muzzling  law  for  the  United 
States,  enforced  by  the  Department  of  Agriculture.  These  sugges- 
dons,  however,  do  not  take  into  consideration  the  discrimination  bc- 
■ween  the  functions  of  the  Federal  and  State  Governments  and  the 
differences  between  the  laws  of  the  United  States  and  those  of  Eng- 
land. The  power  conferred  is  not  in  all  cases  sufficient  to  effect  the 
radication  of  a  disease,  for  the  reason  that  the  Federal  Government 
3an  not  enforce  measures  within  a  State  without  the  legislative 
consent  of  the  State  unless  the  animals  affected  are  subjects  of  or 

449 


22  BABIES   OR    HYDROPHOBIA. 

endanger  interstate  commerce.  Its  work,  therefore,  without  the  co 
operation  of  the  States  affected,  is  limited  to  interstate  traffic,  and 
quarantine  lines  are  thus  made  to  follow  State  lines.  The  department 
is  always  willing  to  cooperate,  so  far  as  possible,  with  any  State 
which  requests  assistance  in  eradicating  an  infectious  disease.  But 
such  a  State  must  necessarily  have  the  proper  laws  by  which  the  con- 
trol of  the  disease  is  made  possible.  "Wlien  a  disease  such  as  rabies 
is  confined  within  a  State  it  does  not  come  under  the  jurisdiction  of 
the  Federal  Government  and  can  not  be  treated  as  the  infectious 
diseases  pleuro-pneumonia  and  foot-and-mouth  disease,  which  spread 
from  State  to  State  and  become  a  serious  menace  to  interstate  traffic. 
The  Department  of  Agriculture  could  quarantine  against  States 
where  the  rabies  exists,  but  it  can  readily  be  seen  that  owing  to  the 
great  freedom  of  movement  which  dogs  enjoy  it  would  be  impracti- 
cable to  enforce  such  a  quarantine  further  than  to  require  all  dogs 
to  be  muzzled  which  are  being  transported  interstate  by  common  car- 
riers. Such  a  requirement  would  give  an  infinitesimal  amount  of 
protection,  as  these  dogs  would  be  beyond  the  Federal  jurisdiction 
after  reaching  the  State  for  which  they  were  destined. 

If  all  States  should  enact  muzzling  laws,  or  if  the  State  boards  of 
health.  State  sanitary  boards,  and  municipal  authorities  in  the  in- 
fected States  should  be  empowered  to  issue  and  enforce  regulations 
compelling  the  muzzling  of  all  dogs  in  the  infected  area  and  the  im- 
pounding or  humane  destruction  of  all  dogs  found  running  at  large, ' 
t]ie  disease  would  soon  be  stamped  out. 

The  necessity  for  a  muzzling  order  having  arisen  in  the  District 
of  Columbia,  the  Secretary  of  Agriculture  notified  the  District  Com- 
missioners of  the  presence  of  this  disease  in  an  alarming  degree 
among  the  canines  of  Washington,  and  requested  the  enactment  of  a 
muzzling  order.  Such  an  order  was  deemed  advisable  because  the 
disease  had  suddenly  jumped  from  12  cases  during  the  fiscal  year  of 
1906-7  to  61  cases  in  1907-8.  The  Commissioners,  however,  believing 
that  the  most  effective  manner  of  dealing  with  the  matter  was  to 
impound  and  destroy  stray  dogs,  started  to  increase  the  dog-catching 
service  on  February  1,  1908,  and  from  this  time  to  June  15,  1908, 
there  were  2,702  dogs  impounded  as  compared  with  1,185  dogs 
impounded  during  the  corresponding  period  for  1907.  The  Presi- 
dent of  the  United  States  became  interested  in  the  subject,  and  the 
Commissioners  issued  a  muzzling  order  to  be  effective  for  a  period 
of  six  months.  With  ■  the  extra  wagons  and  force  employed,  the 
number  of  dogs  captured  during  the  period  of  the  muzzling  order 
was  4,355,  as  compared  with  2,794  captured  during  the  corresponding 
period  of  the  preceding  year.  The  cost  of  the  service  for  the  period 
of  the  muzzling  order  was  $6,125,  as  compared  with  $2,243  for  the 

449 


RABIES   OR   HYDROPHOBIA.  23 

corresponding  period  in  the  jDrevioiis  year.  To  further  the  execu- 
tion of  this  order,  146  arrests  were  made  and  134  convictions  secured, 
besides  what  was  accomplished  by  giving  notice  of  a  penalty  for 
violation.  In  1908,  during  the  last  six  months  of  which  the  muzzling 
order  was  enforced,  8,225  dogs  were  impounded,  while  after  the 
expiration  of  the  muzzling  order  only  2,243  dogs  were  impounded 
during  the  first  half  of  1909.  During  the  last  six  months  of  1908, 
the  period  when  muzzling  was  required,  there  were  46  cases  of  rabies, 
while  in  the  first  six  months  of  1909  there  were  only  28  cases.  The 
results  from  the  muzzling  order  were  therefore  becoming  apparent, 
and  an  additional  six  months'  quarantine  was  requested  b}^  the  Secre- 
tary of  Agriculture,  but  this  request  was  not  complied  with  b};^  the 
District  Commissioners. 

In  the  last  half  of  1909  there  were  only  24  cases,  but  in  the  first 
half  of  1910  the  number  rose  to  34.  During  this  time  new  Com- 
missioners came  into  office,  and  as  the  disease  persisted  and  showed 
a  tendency  to  increase,  they  issued  another  muzzling  order,  taking 
effect  August  11,  1910.  Since  that  time  the  number  of  cases  has 
gradually  decreased,  notwithstanding  the  fact  that  owing  to  the 
insufficiency  of  the  appropriation  the  authorities  have  been  unable 
to  enforce  the  order  adequatel}^ 

In  order  to  secure  State  and  municipal  legislation  for  the  control 
of  rabies  it  wall  require  concerted  action  on  the  part  of  all  interested 
parties,  whether  professional  men  or  laymen,  to  prove  to  the  public 
the  need,  value,  and  benefits  of  such  a  procedure.  With  such  legis- 
lation properly  enforced  no  dog  would  be  seen  running  at  large  with- 
out a  muzzle.  Those  contracting  the  disease  would  be  unable  to 
transfer  the  virus  to  other  animals.  Monetary  loss,  untold  suffering, 
and  death  among  both  human  beings  and  animals  caused  by  the 
disease  would  rapidly  decrease,  and  in  a  relatively  short  period  rabies 
would  be  eradicated  from  our  country.  After  reaching  this  desired 
goal  the  reappearance  of  the  disease  could  be  readily  prevented  by  a 
six  months'  quarantine  of  all  dogs  imported  into  the  United  States 
from  countries  where  rabies  is  prevalent. 

O 


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